Breast lumps — recommended tests and procedures to evaluate a breast lump for breast cancer
You've noticed a change in one of your breasts. There's no mistaking the breast lump because it feels noticeably different from the surrounding breast tissue. Finding a breast lump or some other change in your breast may stir fears of breast cancer — and understandably so.
But the odds are in your favor. Most breast lumps — as many as four out of five biopsied — are benign (noncancerous). However, you'll need to have the breast lump evaluated by a doctor to be certain you don't have cancer.
If evaluation of the breast lump reveals breast cancer, you've taken a vital step toward dealing with the disease. Early detection gives you the best chance for successful treatment.
Understand how normal breast tissue feels
During a breast self-exam, you'll feel tissues of varying consistency. Glandular tissue usually feels firm and slightly rope-like, bumpy or lumpy (nodular). Surrounding fat tissue is soft. The contrast between these two types of tissue is often more pronounced just before your period and generally more prominent in the upper, outer region of the breast — near your armpit.
Besides changes related to your menstrual cycle, breast tissue also changes as you age, becoming more fatty and less dense over time. You may find that your breast-related symptoms, such as tenderness or lumpiness, also differ over the course of your menstrual cycle and as you get older.
When to go to the doctor
If you've found a breast lump or detected a change in one of your breasts, check your other breast. Some lumpiness may be normal — especially if your other breast feels the same to you.
But make an appointment with your doctor if:
- The breast lump is new or unusual and feels different from breast tissue in that breast or your other breast.
- The breast lump doesn't go away after your next menstrual period.
- The breast lump changes or gets bigger.
- You have bloody, possibly spontaneous, discharge from your nipple.
- You notice skin changes on your breast, such as redness, crusting, dimpling or puckering.
- Your nipple is turned inward (inverted), although it isn't normally positioned that way.
In the doctor's office: First look at the breast lump
Evaluation of a breast lump begins with a clinical breast examination. During an office visit, your doctor questions you about your symptoms and examines your breasts. He or she visually inspects your breasts, noting their shape and size, the condition of the overlying skin and whether your nipple is inverted. Your doctor then gently feels your breasts and armpits for signs of lumps or prominent nodular areas that are distinct from surrounding tissue. Your doctor also checks for any areas of thickening that feel different from the surrounding tissue.
If your doctor confirms that you have a breast lump or other area of concern, the next step is to determine whether it's fluid-filled or solid. If it's fluid-filled, it's probably a cyst. If it's solid, it could be a fibroadenoma — a benign breast tumor — or it could be breast cancer.
Further evaluating the breast lump: Possible tests and procedures
To further evaluate a breast lump — including determining whether it's fluid-filled or solid — your doctor may recommend one or a few of these tests or procedures.
Fine-needle aspiration
Your doctor performs fine-needle aspiration (FNA) during an office visit or refers you to a surgeon or radiologist for this procedure.
In FNA, the doctor inserts a thin, hollow needle into the lump and removes (aspirates) any fluid. Ultrasound — a noninvasive procedure that uses sound waves to create images of organs and tissues — may be used to ensure accuracy. If the fluid withdrawn is straw-colored and not bloody, the lump is a benign cyst. It will probably disappear with aspiration.
If the doctor performs the FNA without ultrasound guidance, he or she will probably ask you to come back for follow-up in four to six weeks. If the breast lump has returned during that time, it requires further evaluation.
If the fluid withdrawn through FNA contains blood, it will be sent to a laboratory for analysis. If no fluid comes out, the lump is likely solid and you'll need further tests to determine whether it's cancer.
Ultrasound
Your doctor might not perform FNA right away, opting instead for an ultrasound. If you don't feel any pain associated with the lump, and the ultrasound confirms that it's a cyst, you won't need aspiration. If you do have pain, the doctor can use ultrasound to guide FNA. Removing the fluid from the cyst helps relieve the pain. If ultrasound reveals that the lump is solid, the doctor can collect a small amount of breast tissue with a needle — a procedure known as fine-needle aspiration biopsy. Samples collected go to a laboratory for analysis.
Mammography
Mammography uses X-rays to reveal early evidence of cancer. It can detect calcium deposits (microcalcifications) that mark benign or cancerous (malignant) conditions. Diagnostic mammography helps your doctor investigate lumps and other signs such as pain, nipple discharge, areas of thickening, or change in breast size, shape or overlying skin. It differs from screening mammography — a test done when there are no particular breast concerns — which usually requires only two standard views of your breasts.
A diagnostic mammogram requires views at higher magnification from more angles, and it focuses on the area where the lump is. It can help the radiologist and surgeon precisely locate and determine the size of the lump or other abnormality. Findings may indicate whether the area of concern is benign or cancerous. If it appears to be cancerous, you'll need a needle biopsy and possibly further surgical treatment.
Depending on your age, your doctor might rely on ultrasound to make a diagnosis — either alone or in conjunction with mammography. Because a younger woman's breasts are denser than are an older woman's breasts, a mammogram on a younger woman can be more difficult to interpret. In general, if you're younger than 35, ultrasound may be the only imaging test ordered. If you're 35 or older, your doctor might order a diagnostic mammogram of both breasts and an ultrasound of the breast lump.
Magnetic resonance imaging
In conjunction with mammography, magnetic resonance imaging (MRI) can be of help in distinguishing between benign and cancerous lumps — and it's becoming more and more widely used. Cancerous tissue requires a greater blood supply than does normal tissue to support the growth of a malignant tumor. Because MRI shows greater contrast in areas of increased blood supply, your doctor can tell which areas might be cancerous and which aren't, based on the images. Your doctor may recommend an MRI if he or she still has concerns about a breast lump despite normal mammography and ultrasound test results.
Needle biopsy
If the breast lump is solid, your doctor obtains a tissue sample through fine-needle aspiration biopsy, which is similar to FNA, but uses a special needle to collect a sampling of cells and not just fluid. Alternatively, you may undergo core needle biopsy, which uses a larger needle to obtain a small, solid core of tissue. Ultrasound can help ensure that the needle is in the right position to get a sample of the breast lump. Your doctor takes multiple samples — three to six or more — to obtain several segments of tissue. These samples go to a laboratory for analysis.
With FNA biopsy, you may or may not receive a local anesthetic. Sometimes the needle that delivers the anesthetic causes more discomfort than the biopsy itself. But with a core needle biopsy, you'll receive a local anesthetic to numb the area. With each type of biopsy, the entire procedure can take up to an hour.
Stereotactic biopsy
This type of needle biopsy uses mammography to pinpoint an abnormal area that shows up on a breast-imaging test but isn't felt during a clinical examination. The technique uses stereo images — images of the same area obtained from different angles — to find (localize) the area of concern, and a radiologist or surgeon removes a sample of breast tissue through a hollow needle. Stereotactic biopsy is often used for evaluation of calcifications and lumps seen on mammograms that aren't easy for your doctor to feel (palpate).
For this procedure, you lie facedown (prone) on a table with your breast placed through an opening in the table. The mammography unit compresses your breast while a computer captures images and calculates the position of the area of concern. You receive a local anesthetic to numb the skin.
With computer guidance, the radiologist positions a device containing a hollow needle. Keeping the needle in place, the radiologist monitors its position by using the mammogram images. Tissue samples are removed and sent for analysis. Stereotactic biopsy typically lasts less than an hour, and you'll probably resume normal activity within a day.
Excisional biopsy
This type of biopsy — also called surgical biopsy or lumpectomy — removes the entire breast lump as well as some surrounding breast tissue for analysis. A surgeon performs this procedure using local or general anesthesia. The surgeon makes an incision in your breast and removes the entire breast lump, which then goes to a laboratory for analysis.
If you have a biopsy performed, you should have your test results in about a week.
Follow-up to breast lump evaluation
After you've undergone a clinical breast exam, imaging tests and a needle biopsy, your doctor checks to see that all findings are in agreement. Your doctor may suspect that a breast lump is cancerous after the clinical breast exam, the mammography results may show areas of suspicion, but the pathology results from the needle biopsy reveal benign tissue. In this case, despite benign biopsy results, your doctor can't make the determination that you don't have breast cancer. To be certain that the breast lump isn't cancerous, your doctor will probably refer you to a surgeon for a consultation.
If, after the clinical breast exam, your doctor thinks your breast lump likely isn't cancerous, the mammography results are normal and the needle biopsy is benign, you and your doctor can keep a close watch on the area for a few months. If your breast lump changes at all, your doctor will probably send you for a surgical consultation at that point.
Remember that a normal mammogram doesn't mean the breast lump you feel isn't cancer. See your doctor right away for re-evaluation of the breast lump if you notice any changes or if you develop any new areas of concern.
Last Updated: 05/17/2006
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